Endoscopic surgical techniques have become widely accepted among the medical community. There are numerous benefits associated with the use of endoscopic surgical techniques rather than conventional open surgical techniques. It has been found that avenues for infection are greatly reduced and the patient typically has a shortened post-operative recuperative period. It is not unusual for the postoperative period to be shortened from weeks to several days, and, out patient endoscopic surgery is becoming evermore typical. The term endoscopic as used herein is defined to include endoscopic, laparoscopic, arthroscopic and thorascopic.
In a typical endoscopic surgical procedure, the abdominal cavity of a mammal is typically insufflated with a sterile gas, such as carbon dioxide, in order to provide increased maneuvering room within the body cavity for endoscopic instruments. Then, conventional trocars are inserted into the patients body cavity through the surrounding skin, tissue, and musculature. A conventional trocar typically consists of a trocar cannula which houses an elongated trocar obturator. Trocar obturators typically have a piercing point, although other types of obturators are also available. Once the trocar has been positioned within the body cavity, proximal to the target surgical site, the trocar obturator is removed leaving the trocar cannula as a pathway to the body cavity. The surgeon will place various types of endoscopic surgical instruments through the trocar in order to access the target surgical site where the surgical procedure will be performed. Examples of endoscopic instruments include ligating clip appliers, electrosurgical instruments, endoscopes, tissue graspers, needle graspers, cannulas, tissue manipulators, and the like.
Although endosurgical procedures and techniques offer many advantages, there are some deficiencies associated with these procedures and techniques. In particular, when the surgeon is operating using endoscopic surgical procedures, he is typically using an endoscope which is positioned within the body cavity through a trocar. The endoscope is typically connected to a video camera and the output from the video camera is displayed on a video monitor. The surgeon typically views the display on the video monitor as he manipulates instruments within the body cavity to access the target surgical site and perform the actual surgical procedures. The video display only provides the surgeon with two-dimensional input and there is a consequent loss of depth perception. This lack of depth perception may result in the surgeon overshooting or undershooting the target surgical site as he attempts to position his endoscopic instruments within the body cavity.
When ligating a blood vessel, the surgeon typically positions the endoscopic ligating clip applier around a blood vessel and applies clips to either side of an intended cut. Then the surgeon removes the ligating clip applier from the patient's body cavity and inserts a cutting device such as endoscopic scissors. Often the maneuvering of the endoscopic scissors to the ligated blood vessel is time consuming and potentially hazardous to the patient since the surgeon is attempting to maneuver an instrument in three dimensional space with only two-dimensional visual input. If appropriate care is not taken, it is possible for the surgeon to accidentally cut or puncture vessels or organs as the surgeon attempts to position the scissors about the ligated blood vessel.
What is needed in this art is an endoscopic surgical instrument which would apply a ligating clip to a blood vessel or tissue and which would also have the capability of cutting the blood vessel or tissue, thereby eliminating the need to withdraw a ligating clip applier and insert a separate cutting instrument.